Elderly Heart Disease Patients Research Articles

Diagnostic and Predictive Value of Brachial–Ankle Pulse Wave Velocity and Pulse Pressure Index for Coronary Heart Disease in Elderly Patients With Hypertension

Abstract OBJECTIVE To explore the diagnostic and predictive value of pulse pressure index (PPI) and brachial–ankle pulse wave velocity (baPWV) for coronary heart disease (CHD) in elderly patients with hypertension. METHODS A total of 307 elderly patients who had chest pain or chest distress and coronary angiography were enrolled. According to the Gensini score, patients with CHD (n = 260) were divided into low-risk group (<20 points, n = 96), moderate-risk group (20–40 points, n = 80), and high-risk group (>40 points, n = 84). baPWV was measured using an ankle–brachial index and pulse wave measuring device. Multivariate logistic regression analysis was used to analyze the risk factors of CHD. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of baPWV and PPI for CHD. RESULTS PPI and baPWV of elderly hypertensive patients with CHD at low, moderate, and high risk were higher than those without CHD [PPI: 0.43 ± 0.04, 0.45 ± 0.04, 0.45 ± 0.05 vs. 0.41 ± 0.05, F = 31.768, P < 0.001; baWV: 1,671 (1,587–1,755), 1,717 (1,597–1,843), 1,780 (1,661–1,960) vs. 1,570 (1,477–1,699) cm/s, X2 = 60.918, P < 0.001]. With the increase in CHD severity, the PPI and baPWV were significantly increased (P < 0.05). Spearman/Pearson correlation analysis showed that the Gensini score was positively correlated with baPWV and PPI, respectively (both P < 0.001). Multivariate logistic regression analysis showed that baPWV, PPI, and systolic blood pressure were the influencing factors of CHD in hypertensive patients. The areas under the ROC curve (95% CI) of baPWV, PPI, and their combination for diagnosing CHD were 0.792 (0.723–0.861), 0.708 (0.625–0.792), and 0.837 (0.779–0.895), respectively, and was significantly different between baPWV or PPI alone and the combination of the 2 (Z = −2.178, P = 0.029; Z = −3.330, P = 0.001). CONCLUSIONS Elevations of baPWV and PPI are positively correlated with the severity of CHD. Both baPWV and PPI have a diagnostic and predictive value for CHD in elderly hypertensive patients, and the combination of baPWV and PPI is more accurate.

Establishment of a diagnostic model of coronary heart disease in elderly patients with diabetes mellitus based on machine learning algorithms.

OBJECTIVETo establish a prediction model of coronary heart disease (CHD) in elderly patients with diabetes mellitus (DM) based on machine learning (ML) algorithms.METHODSBased on the Medical Big Data Research Centre of Chinese PLA General Hospital in Beijing, China, we identified a cohort of elderly inpatients (≥ 60 years), including 10,533 patients with DM complicated with CHD and 12,634 patients with DM without CHD, from January 2008 to December 2017. We collected demographic characteristics and clinical data. After selecting the important features, we established five ML models, including extreme gradient boosting (XGBoost), random forest (RF), decision tree (DT), adaptive boosting (Adaboost) and logistic regression (LR). We compared the receiver operating characteristic curves, area under the curve (AUC) and other relevant parameters of different models and determined the optimal classification model. The model was then applied to 7447 elderly patients with DM admitted from January 2018 to December 2019 to further validate the performance of the model.RESULTSFifteen features were selected and included in the ML model. The classification precision in the test set of the XGBoost, RF, DT, Adaboost and LR models was 0.778, 0.789, 0.753, 0.750 and 0.689, respectively; and the AUCs of the subjects were 0.851, 0.845, 0.823, 0.833 and 0.731, respectively. Applying the XGBoost model with optimal performance to a newly recruited dataset for validation, the diagnostic sensitivity, specificity, precision, and AUC were 0.792, 0.808, 0.748 and 0.880, respectively.CONCLUSIONSThe XGBoost model established in the present study had certain predictive value for elderly patients with DM complicated with CHD.

Association of Genetic Polymorphism of Tumor Necrosis Factor-α in the Development of Coronary Heart Disease in Elderly Patients

The research project outlines a new look at the concept of "inflammaging" and the role of the subclinical inflammatory process in various age-associated pathology, in particular coronary heart disease. Particular attention is paid to the tumor necrosis factor-α -cytokine, which plays an important role in the pathogenesis of chronic inflammatory processes and in the aging process. The increased content of tumor necrosis factor-α leads to the emergence and accumulation of various diseases, disability and mortality of elderly and senile people.
 Tumor necrosis factor-α influences various risk factors for cardiovascular pathology. This substance aggravates various breakdowns in metabolism, primarily causing insulin resistance. Tumor necrosis factor-α is a key cytokine that stimulates bone resorption (osteoporosis) and sarcopenia. Currently available data prove the important role of tumor necrosis factor-α in various age-associated pathologies.

Drug interactions and adverse events in elderly heart disease patients

Chronic and multiple diseases are more prevalent in elderly individuals and, epidemiological highlight can be given to cardiovascular conditions requiring multi-drug therapies, which favor the occurrence of drug interactions. This study aims to analyze potential drug interactions and correlate them with adverse events in elderly heart-disease patients in a hospital setting. This is a prospective description of the analysis of medical prescriptions and records of 80 patients, with data collection performed by using validated instruments during a seven-month period. The drug interactions found were indicated by scientifically recognized databases and subsequently treated statistically with adequate software. 1841 potential interactions between drugs were detected, of which 74.1% did not show any therapeutic benefits, with antithrombotic and analgesic drugs accounting for the worst results. The number of potential interactions was proportional to the occurrence of adverse events, classified at 87.3% as moderate to severe. It is concluded from such results that there is a proportionality between the occurrence of potential drug interactions and the detection of adverse events, with therapeutic management being of great importance for safety, quality and affordability of the treatment.

Mortality and compliance with secondary prevention goals of ischaemic heart disease in patients ≥70 years: observational study

Introduction and objectivesThe benefit of secondary prevention of ischaemic heart disease in terms of mortality in people of advanced age has not been well demonstrated. In this study we analyse the relationship of all-cause mortality with meeting the objectives of secondary prevention of ischaemic heart disease in elderly patients. MethodsAn observational study of a sample of 106 patients ≥70with a history of acute coronary syndrome in the previous year. We analysed the association between meeting the objectives of secondary prevention of ischaemic heart disease and global mortality at 3 years. ResultsDuring the three years of follow-up, 15.1% of the patients died. Control of LDL cholesterol was associated with lower mortality (HR.08 [.01–.61], p.014). By contrast, strict control of blood pressure was associated with a tendency towards higher mortality (HR3.2 [.9–11.47], p.073). ConclusionControl of LDL-c in the elderly population with ischaemic heart disease is the single therapeutic objective that can have a favourable effect on medium-term survival.

Metabolic features of elderly patients with multivessel coronary lesions

Peculiarities of the course of coronary heart disease in elderly patients with multivessel lesions of the coronary bed and uncorrected metabolic disorders, in particular lipid profile, are analyzed in the article. The study included 74 patients older than 65 years of both sexes with lesions of the left main coronary artery (LMCA) in combination with a lesion of two or more coronary arteries according to coronary arteriography. The authors found that the negative dynamics of carbohydrate metabolism is a predictor of the deterioration of the course of coronary heart disease (CHD) in elderly patients. An adherence to therapy and glycemic control significantly increase the chances of a favorable course of the disease in elderly patients with multivessel coronary lesions.An elevated level of triglycerides, very low-density lipoproteins cholesterol, and an overall atherogenic coefficient, are a predictor of re-hospitalization associated with coronary insufficiency in elderly patients with multivessel coronary lesions.

空巢老年冠心病患者常见问题的护理概述

空巢老年冠心病患者常见问题的护理概述

Clinical Impact of Valvular Heart Disease in Elderly Patients Admitted for Acute Coronary Syndrome: Insights From the Elderly-ACS 2 Study

BackgroundElderly patients are under-represented in clinical trials and registries, and a gap of evidence exists for clinical decision making in the setting of acute coronary syndromes (ACS). We aimed to assess the prevalence and independent prognostic impact of valvular heart disease (VHD) diagnosed during the index hospitalization on clinical outcomes among elderly patients with ACS. Included VHDs were moderate-to-severe mitral regurgitation (MR), moderate-to-severe aortic stenosis (AS), or both combined. MethodsWe explored the Elderly-ACS 2 dataset, which includes patients older than 74 years of age diagnosed with ACS and managed invasively. The primary endpoint was a composite of all-cause death, myocardial infarction, disabling stroke, and rehospitalization for heart failure at 1 year; the secondary endpoint was death for cardiovascular causes. Patients were stratified into 4 groups: no VHD, moderate-to-severe MR, moderate-to-severe AS, and both moderate-to-severe MR and AS. ResultsOf the 1443 subjects enrolled, 190 (13.2%) had moderate-to-severe MR, 26 (1.8%) had moderate-to-severe AS, and 13 (0.9%) had both moderate-to-severe MR and AS. When compared with those with no VHD, patients with moderate-to-severe MR had hazard ratios (HRs) for the primary endpoint of 2.04 (95% confidence interval [CI], 1.36-3.07], those with moderate-to-severe AS had HRs of 3.10 (95% CI, 1.39-6.93), and those with both moderate-to-severe MR and AS had HRs of 4.00 (95% CI, 1.65-9.73] (all P < 0.01). Patients with moderate-to-severe MR also had increased risks of cardiovascular death (HR 3.17; 95% CI, 1.57-6.42; P < 0.01), whereas in those with moderate-to-severe AS or both moderate-to-severe MR and AS, a nonsignificant increased risk was observed. ConclusionsIn a contemporary cohort of elderly patients admitted for ACS, VHD was found in 1 of 5 subjects and had an independent, consistent impact on prognosis.

To Study Clinical Profile of Ischemic Heart Disease in Elderly Patients and the Use of Percutaneous Transluminal Coronary Angioplasty (PTCA) and it’s Outcome at a Tertiary Care Centre

To Study Clinical Profile of Ischemic Heart Disease in Elderly Patients and the Use of Percutaneous Transluminal Coronary Angioplasty (PTCA) and it’s Outcome at a Tertiary Care Centre

P1781Burden of significant valvular heart disease in elderly patients presenting with acute coronary syndromes

Abstract Background Elderly patients with acute coronary syndromes (ACS) represent a group seldom included in clinical trials and in whom robust data regarding mid-term impact of significant concomitant valvular heart disease are lacking. Purpose Our aim was to evaluate the impact of moderate-to-severe mitral regurgitation (MR), moderate-to-severe aortic stenosis (AS), or both conditions combined on a primary composite endpoint of mortality, myocardial infarction, disabling stroke and re-hospitalization for cardiovascular causes or bleeding within one year in a population of ACS patients included in the Elderly ACS 2 trial. Methods In the multicenter Elderly II ACS Study, 1,443 patients aged &gt;74 y undergoing percutaneous coronary intervention (PCI) for ACS, were randomly assigned to receive prasugrel (5 mg) or clopidogrel (75 mg) and were prospectively followed for 1 year. Amongst these, 1,102 patients received full echocardiographic assessment and were included in the post-hoc analysis (Table 1). Results Survival analysis showed that patients presenting with moderate-to-severe MR, AS or both (Figure 1A), had worse outcome in terms of primary endpoint (p&lt;0.001) as compared to no valve disease. A multivariable Cox regression model revealed that the presence of moderate-to-severe MR, AS or both were independent predictors of primary endpoint (HR 1.84; HR 2.8; HR 2.9 and p&lt;0.001; p=0.004; p=0.01, respectively), regardless of age, gender, left ventricular ejection fraction, diabetes mellitus, history of cancer and total number of diseased vessels (Figure 1B). Table 1 Overall No residual valvular heart disease Moderate-to-severe MR Moderate-to-severe AS Both Age (y) 80.68±4.50 80.40±4.42 81.47±4.45 82.92±5.42 83.23±5.42 Male gender 652 (59.2) 538 (61.6) 92 (48.4) 19 (73.1) 3 (23.1) STE-ACS 420 (38.1) 319 (36.5) 91 (47.9) 6 (23.1) 4 (30.8) Diabetes mellitus 203 (18.4) 158 (18.1) 35 (18.4) 5 (19.2) 5 (38.5) LVEF (%) 48.30±9.58 49.26±9.27 44.61±9.45 48.50±11.22 38.31±10.87 History of cancer 32 (2.9) 26 (3.0) 3 (1.6) 2 (7.7) 1 (7.7) Tot number of diseased vessel 2.31±1.05 2.28±1.04 2.49±1.05 2.04±0.87 2.54±1.13 Data are expressed as mean ± SD or count (valid %). Figure 1 Conclusions Moderate-to-severe MR and AS represent significant predictors of 1-year outcome in elderly patients hospitalized for ACS, even when other well-established prognostic factors are taken into account and after revascularization with PCI. Therefore, these patients should be carefully screened for the presence of valvular heart disease at the time of presentation and the need for surgical or percutaneous correction should be assessed accordingly. Acknowledgement/Funding None

Mortalidad y cumplimiento de los objetivos de prevención secundaria de la cardiopatía isquémica en pacientes ≥ 70 años: estudio observacional

Introduction and objectivesThe benefit of secondary prevention of ischaemic heart disease in terms of mortality in people of advanced age has not been well demonstrated. In this study we analyse the relationship of all-cause mortality with meeting the objectives of secondary prevention of ischaemic heart disease in elderly patients. MethodsAn observational study of a sample of 106 patients ≥70 with a history of acute coronary syndrome in the previous year. We analysed the association between meeting the objectives of secondary prevention of ischaemic heart disease and global mortality at 3 years. ResultsDuring the 3 years of follow-up, 15.1% of the patients died. Control of LDL cholesterol was associated with lower mortality (HR=.08 [.01-.61], p=.014). By contrast, strict control of blood pressure was associated with a tendency towards higher mortality (HR=3.2 [.9-11.47], p=.073). ConclusionControl of LDL cholesterol in the elderly population with ischaemic heart disease is the single therapeutic objective that can have a favourable effect on medium-term survival.

Correlation between serum cathepsin S level and severity of coronary heart disease in elderly patients

Objective To study the expression level of cathepsin S in elderly patients with different degree of coronary heart disease(CHD), and to evaluate the correlation between cathepsin S level and the severity of CHD. Methods A total of 126 elderly patients with CHD were enrolled, including 36 cases with acute myocardial infarction(group AMI), 48 cases with unstable angina(group UAP), and 42 cases with stable angina(group SAP). During the same period, 40 healthy subjects were selected as controls.Venous blood was collected immediately after admission.Arterial blood was taken through radial/femoral artery sheath in AMI patients who underwent primary percutaneous coronary intervention, and coronary arterial blood was taken in AMI patients undergoing intracoronary thrombus aspiration.SYNTAX score was assessed in patients undergoing coronary angiography.Serum levels of high sensitivity C-reactive protein(hs-CRP), matrix metalloproteinase-9(MMP-9)and cathepsin S were determined in all specimens and compared between groups. Results Serum levels of cathepsin S, MMP-9 and hs-CRP were higher in CHD patients than in the control group(P<0.05). Among CHD patients, group AMI had the highest serum levels of cathepsin S, MMP-9 and hs-CRP, followed by group UAP and group SAP(F=106.830, 197.035 and 310.442, all P=0.000). Spearman's rank correlation test suggested that cathepsin S level was positively correlated with serum levels of MMP-9(r=0.816, P=0.000)and hs-CRP(r=0.827, P=0.000). SYNTAX score was positively correlated with serum levels of cathepsin S(r=0.581, P=0.000), MMP-9(r=0.511, P=0.000), and hs-CRP(r=0.557, P=0.000). Among the 24 patients with AMI who underwent intracoronary thrombus aspiration, the levels of cathepsin S, MMP-9 and hs-CRP were higher in coronary artery blood than in peripheral artery blood(t=217.288, 3.177 and 681.479, all P=0.000). Cathepsin S and hs-CRP levels in peripheral arterial blood had positive correlations with those in coronary arterial blood respectively(r=0.962 and 0.494, P=0.000 and 0.014), but such correlation between in peripheral arterial blood versus in coronary artery blood was not found in MMP-9 levels(r=-0.188, P=0.380). Conclusions Serum cathepsin S level is higher in elderly CHD patients than in healthy people, increases along with the increased severity of CHD, and positively correlates with the degree of coronary stenosis. Key words: Coronary disease; Cathepsins

Clinical, sonographic characteristics and long-term prognosis of valvular heart disease in elderly patients.

BackgroundValvular heart disease (VHD) is expected to become more prevail as the population ages and disproportionately affects older adults. However, direct comparison of clinical characteristics, sonographic diagnosis, and outcomes in VHD patients aged over 65 years is scarce. The objective of this study was to evaluate the differences in clinical characteristics and prognosis in two age-groups of geriatric patients with VHD.MethodsWe retrospectively enrolled consecutive individuals aged ≥ 65 years from Guangdong Provincial People's Hospital and screened for VHD using transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). Finally, 260 (48.9%) patients were in the 65–74 years group, and 272 (51.1%) were in the ≥ 75-year group. Factors that affected long-term survival was explored. A multivariable Cox hazards regression was performed to identify the predictors of major adverse cardiac events (MACEs) in each group.ResultsIn our population, the older group were more likely to have chronic obstructive pulmonary disease (COPD), degenerative VHD, but with less rheumatic VHD, aortic stenosis (AS) and mitral stenosis (MS). Compared with those aged 65–74 years, the older group had a higher incidence of all-cause death (10.0% vs. 16.5%, P = 0.027), ischemic stroke (13.5% vs. 20.2%, P = 0.038) and MACEs (37.3% vs. 48.2%, P = 0.011) at long-term follow-up. In multivariable Cox regression analysis, mitral regurgitation, a history of COPD, chronic kidney disease, diabetes, hypertension, atrial fibrillation and New York Heart Association (NYHA) functional class were identified as independent predictors of MACEs in the older group.ConclusionAdvanced age profoundly affect prognosis and different predictors were associated with MACEs in geriatric patients with VHD.

Surgical treatment of acquired valvular heart disease in elderly patients

This article provides an overview of studies on indications, surgery and outcomes of valvular heart disease surgery in elderly patients.

Relationship of Cystatin-C with coronary artery disease in the elderly patients with diabetes

Objective: To study the relationship between Cystatin C (Cys-C) level and the development of coronary heart disease in elderly patients with type 2 diabetes mellitus (T2DM). Methods: 120 cases of elderly diabetic patients were involved in this study from October 2013 to November 2015 in Department of Endocrinology and Cardiology. All patients underwent the detection of routine flash dual-source coronary computed tomography angioplasty (CCTA), Cys-C, hemoglobin A1c (HbA1c). According to the difference of CCTA results, the patients were divided into DM1 group (with normal coronary CTA), DM2 group (with a coronary artery stenosis rate < 50%), DM3 group (with a coronary artery stenosis rate of 50%-74%) and DM4 group (with a coronary artery stenosis rate of ≥ 75%). The levels of Cys-C and HbA1c were compared in the four groups. Results: The blood levels of Cys-C and HbA1c showed significant differences between DM1, DM2, DM3 and DM4 group ( p < .05). The age, heart rate, blood pressure showed no statistical differences between the groups. The level of Cys-C was positively correlated with HbA1c. Conclusions: The blood level of Cys-C in the elderly patients with T2DM increased with the increase of the degree of coronary artery stenosis. Blood Cys-C may be used as an early predictor of coronary artery lesions in elderly patients with T2DM.

Effect of homocysteine, blood lipid level and carotid atherosclerosis on coronary heart disease in elderly patients with hypertension

Objective To investigate the relationship among plasma homocysteine(Hcy), blood lipid levels and carotid atherosclerosis with coronary heart disease in elderly patients with hypertension. Methods A total of 300 elderly patients with hypertension(age>60 years) were selected as study objects, including 150 cases of coronary heart disease patients were diagnosed as CHD group, 150 cases of non coronary heart disease patients in the same period as the control group.Peripheral venous blood was extracted, the homocysteine and blood lipid levels were detected by automatic biochemiealanalyzer, and carotid artery ultrasound examination was performed to analyze the degree of carotid artery atherosclerosis, and the correlation analysis was performed. Results The plasma levels of Hcy in CHD group was significantly higher than the control group, the difference was statistically significant((23.36±6.06) x03BC;mol/L vs.(12.45±3.33) x03BC;mol/L, P<0.05). The levels of TG, TC, LDL-C in CHD group were significantly higher than that of the control group, the differences were statistically significant((2.32±0.37) mmol/L vs.(1.56±0.51) mmol/L, (6.45±0.44) mmol/L vs.(5.56±0.73) mmol/L, (4.12±0.76) mmol/L vs.2.98±0.56) mmol/L, P<0.001). The level of HDL-C in CHD group was significantly lower than the control group, the difference was statistically significant((1.54±0.45) mmol/L vs.(1.76±0.48) mmol/L, P<0.05). The carotid atherosclerosis occurrence rate in CHD group was higher than the control group, the difference was statistically significant(86.00%(129/150) vs.26.00%(39/150), P<0.001). The carotid artery type distribution of two groups was statistically significant(P<0.001). The plasma levels of Hcy with carotid atherosclerosis in CHD group were higher than the patients without carotid atherosclerosis, the difference was statistically significant((29.58±5.76) x03BC;mol/L vs.(16.75±4.24) x03BC;mol/L, t=2.328, P=0.026). Logistic regression showed that Hcy, blood lipid levels, carotid plaque may be the risk factors of coronary heart disease in elderly patients with hypertension. Conclusion High Hcy, high blood lipids and carotid plaque may be related to the occurrence of coronary heart disease in elderly patients with hypertension, the three may have a certain clinical value in predicting the occurrence of coronary heart disease in elderly patients with hypertension. Key words: Homocysteine; Blood lipids; Carotid artery atherosclerosis; Elderly essential hypertension; Coronary heart disease

Aerobic exercise, cardiac function, heart rate recovery and the quality of life of elderly heart disease patients

Objective To explore the effect of aerobic exercise on cardiac function, heart rate recovery and the quality of life of elderly heart disease patients. Methods One hundred senile heart disease patients were studied. They were randomly divided into a control group and an observation group, with 50 in each group. Both groups were provided with the conventional anti-platelet aggregation treatment, dilation of blood vessels and control of blood pressure. The observation group was also given individualized aerobic exercise training. At the outset and after 3 months the cardiac function and heart rate recovery of both groups were observed, and their quality of life was evaluated using the SF-36 life quality scale. Results After the treatment, the average left ventricular ejection fraction of those in the observation group was significantly better than before the treatment, and significantly better than the average among the controls. The average 6-minute walking test time and average maximum oxygen uptake in the observation group were also significantly better than before the treatment and significantly better than among the controls. The average peak heart rate and HRR1 in the observation group had increased significantly, and significantly more than those of the control group. The average total SF-36 score in the observation group was also significantly higher. Conclusion Individualized aerobic exercise can significantly improve cardiac function and promote heart rate recovery in elderly patients with heart disease, which is of clinical value for improving their quality of life. Key words: Aerobic exercise; Elderly; Heart disease; Cardiac function; Heart rate; Quality of life

Application of extracorporeal cardiac shock wave therapy in treating coronary heart disease in the elderly

Objective To evaluate the efficacy and safety of cardiac shock wave therapy (CSWT) in coronary heart disease in elderly patients. Methods Eleven patients with refractory angina pectoris were enrolled. The ischemic area was determined by the 99mTechnetium-MIBI single-photon emission computed tomography (SPECT) and coronary angiography, and treated with CSWT. The CSWT were performed during treatment of 3 months, with 9 times totally. The clinical evaluations included the clinical symptoms, Canadian Cardiovascular Society (CCS) class scores, New York Heart Association class (NYHA), Seattle angina questionnaire (SAQ), 6-min walking distance and the use of dosage of nitroglycerin, left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF). The amelioration of ischemic myocardial was analyzed by SPECT. The safety of CSWT was evaluated by changes in clinical symptoms, ECG monitoring, blood pressure and oxygen saturation, blood levels of creatine kinase, creatine kinase myocardial band isoenzymes (CK-MB), troponin T (TnT), alanine transfer enzyme (ALT), creatinine (CR), brain natriuretic peptide and high sensitive C reactive protein (hs CRP). Results The CCS class scores, NYHA, 6-min walking distance and the dosage of nitroglycerin were significantly improved at 4 and 12 months after treatment as compared with pretreatment. The steady state of angina pectoris and the frequency score in SAQ were significantly improved. The 21 cardio-vessel segments were treated, and the improvement rate of resting myocardial perfusion was 46.2% (6/13), the effective rate was 38.5% (5/13), and the obvious effective rate was 7.8% (1/13) after treatment. The improvement rate of loaded myocardial perfusion was 57.1% (12/21), the effective rate was 47.6% (10/21), and the obvious effective rate after treatment was 9.5% (2/21). There were no significant changes in levels of CK, CK-MB, TNT, ALT, Cr, BNP and hs CRP, heart rate, systolic blood pressure, diastolic blood pressure and oxygen saturation after treatment as compared with pretreatment. Conclusions The CSWT is a safe and effective treatment for coronary heart disease in the elderly, and the curative effect could maintain at least one year. Key words: Coronary disease; Radionuclide imaging; Extracorporeal cardiac shock wave

Analysis of the correlation of the prognosis and blood lipids of heart failure in patients with coronary heart disease

Objective To investigate the relationship between the prognosis of patients with coronary heart disease in elderly heart failure between lipid levels. Methods 720 cases of coronary heart disease in elderly patients with heart failure, according to the survival of the follow-up period were divided into survival group and death group, comparing lipid levels in each group of patients, the use of multivariate Cox regression analysis to investigate the effects of lipids in elderly patients with heart failure, coronary artery disease prognosis. Results Age group of death, old myocardial infarction （OMI）, the probability of occurrence of atrial fibrillation, anemia was significantly higher than that of the survival group（ X2 = 5. 626,4. 597,5. 632,6. 461, all P 〈 0.05 ）, HDL-C, EF, ACEI/ARB and statins was significantly lower than those of the survival group（ t = 10. 725,9. 563,8. 457,9. 170 ,P 〈 0.05 or P 〈 0.01 ）. An- giotensin-converting enzyme inhibitors（ ACEI） /angiotensin Ⅱ receptor antagonists（ARB） would help to improve the prognosis（ r = 0. 678 ,P 〈 0. 01 ） , whereas low levels and low levels of HDL-C, NYHA Ⅲ-grade IV, age was a risk fae- tor（r =1.052,2.298,2.586,all P〈0. 01）. Conclusion There is a close contact between HDL-C and prognosis of heart failure in elderly patients with coronary heart disease,in order to improve the prognosis of patients,it ean be ap- propriately managed to elevate HDL-C levels. Key words: Coronary disease ; Heart failure, congestive ; Prognosis ; Lipoproteins ; Aged

Protocolo diagnóstico de las valvulopatías en el anciano

Over the last decades, diagnosis, treatment and monitoring of valvular heart disease in elderly patients have changed. Elderly patients undergo more diagnostic and therapeutic procedures due to the significant increase of life expectancy and the improvement in quality of life.Significant development in the cardiovascular area with improved percutaneous treatments and surgical procedures has taken place in recent decades. Different studies show that elderly patients who have been operated on for valvulopathies improve their quality of life and their survival rates are similars to that of the population of the same age. For this reason, therapeutic approaches to valvular elderly patients are changing.The aim of the diagnostic protocol is to present a guide for physicians in order to select the best possible management strategies for the individual patient suffering from a specific valvular heart disease.